Andrei H. Iagaru, MD, FACNM, presented “Molecular Imaging” during the 33rd International Prostate Cancer Update on January 24, 2023, in Vail, Colorado.
How to cite: Iagaru, Andrei H. “Molecular Imaging.” January 24, 2023. Accessed Jul 2024. https://grandroundsinurology.com/molecular-imaging/
Molecular Imaging – Summary
Andrei H. Iagaru, MD, FACNM, discusses the roles of nuclear medicine modalities, prostate-specific membrane antigen (PSMA), and theranostics in the treatment of prostate cancer. He notes that three specific modalities – PET/MRI, PET/CT, and SPECT/CT – can all contribute to the prostate cancer treatment process. Dr. Iagaru explains the tracer principle in nuclear medicine and describes the PET/MRI and PET/CT modalities, noting that PET/MRI is useful in the early stages of prostate cancer. He describes the replacement of PET/MRI with PET/CT in later prostate cancer stages, followed by the application of SPECT/CT.
Dr. Iagaru then reviews the importance of PSMA and its aid in identifying clinically significant prostate cancer. He cites data on PSMA use for biopsy guidance and high-intensity focus ultrasound while also referencing studies showing value in patients with high-risk prostate cancer undergoing PSMA PET/MRI before prostatectomy. He then reviews PSMA at biochemical recurrence, citing the CONDOR study and a study from Stanford University, the latter of which found a 65% positive 18F-DCFPyL PET/CT scan rate among patients with prostate-specific antigen (PSA) under 0.5.
Dr. Iagaru stresses the importance of modern scanners, highlighting the inability of 20-year-old scanners to track PSA under 0.5. He then demonstrates the use of PSMA theranostics in prostate cancer treatment by explaining diagnostic and therapy compounds, highlighting VISION trial results and subsequent approval of the 177Lu-PSMA-617 therapy. Dr. Iagaru refers back to SPECT/CT use and emphasizes its capabilities in post-treatment evaluation and theranostic considerations. He concludes with praise for nuclear medicine advancements in the treatment of prostate cancer, signaling the reality of personalized medicine thanks to molecular imaging, theranostics, and new data.
About The 33rd Annual International Prostate Cancer Update:
The International Prostate Cancer Update (IPCU), founded in 1990, is a multi-day CME conference focused on prostate cancer treatment updates with expert, international faculty. It is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer. The 33rd iteration of the meeting occurred January 22-25, 2023 in Vail, Colorado. To view more educational presentations from IPCU 33, visit our collection page.
ABOUT THE AUTHOR
Dr. Iagaru is a Professor of Radiology and Chief of the Division of Nuclear Medicine and Molecular Imaging at Stanford University Medical Center. He completed medical school at Carol Davila University of Medicine in Bucharest, Romania, and an internship at the Drexel University College of Medicine Graduate Hospital in Philadelphia, Pennsylvania. He began his residency at the University of Southern California (USC) Keck School of Medicine in Los Angeles in the Division of Nuclear Medicine, where he was the chief resident. Dr. Iagaru finished his residency and completed a PET/CT fellowship at Stanford University’s School of Medicine in the Division of Nuclear Medicine. His research interests include PET/MRI and PET/CT for early cancer detection; clinical translation of novel PET radiopharmaceuticals; peptide-based diagnostic imaging and therapy; and targeted radionuclide therapy.
Since joining the faculty at Stanford, Dr. Iagaru has received several awards including the Society of Nuclear Medicine (SNM) 2009 Image of the Year Award; the AuntMinnie 2016 Best Radiology Image; the American College of Nuclear Medicine (ACNM) Mid-Winter Conference 2010 Best Essay Award; the 2009, 2014 and 2015 Western Regional SNM Scientist Award; the 2011 SNM Nuclear Oncology Council Young Investigator Award; and a Stanford Cancer Center 2009 Developmental Cancer Research Award in Translational Science. Dr. Iagaru has presented more than 200 abstracts at national and international meetings and has published more than 140 papers in peer-reviewed journals, as well as seven book chapters and one book.
